Healthcare Provider Details

I. General information

NPI: 1740883321
Provider Name (Legal Business Name): HUMBERTO JAFET AYOROA SOSA I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2Q RUTA 474
ISABELA PR
00662-3900
US

IV. Provider business mailing address

PO BOX 1696
ISABELA PR
00662-1696
US

V. Phone/Fax

Practice location:
  • Phone: 407-844-1261
  • Fax: 787-872-3721
Mailing address:
  • Phone: 407-844-1261
  • Fax: 787-872-3721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier03960304
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: